00
Correct
00
Incorrect
00 : 00 : 00
Session Time
00 : 00
Average Question Time ( Secs)
  • Question 1 - Liam is a 25-year-old man with a diagnosis of cyclical mastalgia. At what...

    Correct

    • Liam is a 25-year-old man with a diagnosis of cyclical mastalgia. At what point would you anticipate his breast pain to be most severe?

      Your Answer: Around menses

      Explanation:

      The intensity of cyclical mastalgia changes depending on the menstrual cycle phase. It is most severe during menstruation and starts during the luteal phase, gradually worsening until menstruation. However, it improves during the follicular phase. This type of mastalgia is linked to hormonal fluctuations and is not influenced by seasonal changes.

      Cyclical mastalgia is a common cause of breast pain in younger females. It varies in intensity according to the phase of the menstrual cycle and is not usually associated with point tenderness of the chest wall. The underlying cause is difficult to identify, but focal lesions such as cysts may be treated to provide symptomatic relief. Women should be advised to wear a supportive bra and conservative treatments such as standard oral and topical analgesia may be used. Flaxseed oil and evening primrose oil are sometimes used, but neither are recommended by NICE Clinical Knowledge Summaries. If the pain persists after 3 months and affects the quality of life or sleep, referral should be considered. Hormonal agents such as bromocriptine and danazol may be more effective, but many women discontinue these therapies due to adverse effects.

    • This question is part of the following fields:

      • Gynaecology And Breast
      6.3
      Seconds
  • Question 2 - A 28-year-old woman comes in with lower abdominal pain. She believes she is...

    Correct

    • A 28-year-old woman comes in with lower abdominal pain. She believes she is approximately 8 weeks pregnant according to her last menstrual period and has been feeling fine until 5 days ago when she started experiencing some lower abdominal discomfort that has been gradually intensifying. What should be avoided during her evaluation?

      Your Answer: Examination for an adnexal mass

      Explanation:

      NICE advises against examining an adnexal mass as it may lead to rupture.

      Understanding Ectopic Pregnancy

      Ectopic pregnancy occurs when a fertilized egg implants outside the uterus. This condition is a medical emergency that requires immediate attention. Women with ectopic pregnancy typically experience lower abdominal pain, which is often the first symptom. The pain is usually constant and may be felt on one side of the abdomen. Vaginal bleeding is another common symptom, which is usually less than a normal period and may be dark brown in color. Women with ectopic pregnancy may also experience dizziness, fainting, or syncope.

      During a physical examination, doctors may find abdominal tenderness and cervical excitation, also known as cervical motion tenderness. However, they are advised not to examine for an adnexal mass due to the risk of rupturing the pregnancy. Instead, a pelvic examination to check for cervical excitation is recommended. In cases of pregnancy of unknown location, serum bHCG levels above 1,500 suggest an ectopic pregnancy.

      In summary, ectopic pregnancy is a serious condition that requires prompt medical attention. Women who experience lower abdominal pain and vaginal bleeding should seek medical help immediately. Early diagnosis and treatment can prevent complications and improve outcomes.

    • This question is part of the following fields:

      • Gynaecology And Breast
      6.8
      Seconds
  • Question 3 - A 57-year-old woman presents with persistent abdominal bloating, lower abdominal pain, and early...

    Correct

    • A 57-year-old woman presents with persistent abdominal bloating, lower abdominal pain, and early satiety for the past 6-9 months. She reports feeling more tired than usual and experiencing slight urinary urgency and frequency. She denies any rectal bleeding or vaginal discharge. Her last period was at the age of 52, and she has had no vaginal bleeding since then. On her previous visits, she was treated for a presumed urine infection and prescribed omeprazole, but neither intervention was effective. She has also tried an over-the-counter antispasmodic and a gluten-free diet with no improvement. Clinical examination reveals no concerning findings. What is the most appropriate next step in managing her symptoms in primary care?

      Your Answer: Trial a selective serotonin reuptake inhibitor (SSRI)

      Explanation:

      Detecting Ovarian Cancer: Symptoms and Testing

      The symptoms of ovarian cancer can be vague, making it difficult to detect in its early stages. Patients may present with persistent bloating, abdominal or pelvic pain, and difficulty eating. Women over the age of 50 who experience these symptoms more than 12 times a month or for more than a month should be offered CA125 testing. If the CA125 level is 35 IU/mL or greater, an urgent ultrasound scan of the pelvis should be arranged.

      It is important to note that symptoms of ovarian cancer can overlap with less serious conditions, such as irritable bowel syndrome (IBS). However, IBS rarely arises for the first time in women over 50, so persistent symptoms should be investigated further.

      Patients who suspect they may have Coeliac disease should be tested before starting a gluten-free diet. The tTG antibody test will produce a negative result if the patient is not consuming gluten, so a daily gluten-containing diet should be followed for at least 6 weeks prior to testing. By being aware of these symptoms and testing options, healthcare professionals can help detect ovarian cancer early and improve patient outcomes.

    • This question is part of the following fields:

      • Gynaecology And Breast
      6.7
      Seconds
  • Question 4 - Linda is a 32-year-old woman who presents with a 6 month history of...

    Correct

    • Linda is a 32-year-old woman who presents with a 6 month history of chronic pelvic pain and dysmenorrhoea that is beginning to impact her daily life, especially at work. During the consultation, Linda mentions experiencing painful bowel movements that begin just before her period and persist throughout it.

      As her healthcare provider, you suspect endometriosis. Linda asks you about the best way to confirm this diagnosis.

      What is the definitive test that can be done to confirm endometriosis for Linda?

      Your Answer: Laparoscopic visualisation of the pelvis

      Explanation:

      According to NICE guidelines, laparoscopy is the most reliable method of diagnosing endometriosis in patients.

      To confirm the presence of endometriosis, it is necessary to perform a laparoscopic examination of the pelvis, regardless of whether a transvaginal or transabdominal ultrasound appears normal.

      If a thorough laparoscopy is conducted and no signs of endometriosis are found, the patient should be informed that she doesn’t have the condition and offered alternative treatment options.

      Endometriosis is a condition where endometrial tissue grows outside of the uterus, affecting around 10% of women of reproductive age. Symptoms include chronic pelvic pain, painful periods, pain during sex, and subfertility. Diagnosis is made through laparoscopy, and treatment depends on the severity of symptoms. First-line treatments include NSAIDs and hormonal treatments such as the combined oral contraceptive pill or progestogens. If these do not improve symptoms or fertility is a priority, referral to secondary care may be necessary. Treatment options in secondary care include GnRH analogues and surgery, with laparoscopic excision or ablation of endometriosis plus adhesiolysis recommended for women trying to conceive. Ovarian cystectomy may also be necessary for endometriomas.

    • This question is part of the following fields:

      • Gynaecology And Breast
      11.8
      Seconds
  • Question 5 - A 28-year-old woman comes to you after finding out she is pregnant two...

    Correct

    • A 28-year-old woman comes to you after finding out she is pregnant two months after getting a progesterone-only implant. She wants to continue the pregnancy but is concerned about the effects of the hormone on the fetus.

      What advice would you give to this patient?

      Your Answer: Remove contraceptive implant

      Explanation:

      Contraceptive Hormones and Pregnancy

      Women who are using contraceptive hormones should not worry about any harm to the fetus if they become pregnant. It is not necessary to terminate the pregnancy for this reason. If the woman chooses to abort the pregnancy, the contraceptive implant can be left in place for ongoing contraception. Referral to an early pregnancy assessment unit or for an anomaly scan is also unnecessary as there is no risk to the fetus.

      However, it is important to remove the progesterone-only implant as soon as pregnancy is confirmed. The only exception to this is if an intrauterine device is in place and pregnancy is diagnosed after 12 weeks. In such cases, the contraception should not be removed. Women can be reassured that contraceptive hormones are safe and effective for preventing pregnancy, and should not hesitate to use them if desired.

    • This question is part of the following fields:

      • Gynaecology And Breast
      2.2
      Seconds
  • Question 6 - Ms. Smith, a 28-year-old woman who is currently 12 weeks into her first...

    Correct

    • Ms. Smith, a 28-year-old woman who is currently 12 weeks into her first pregnancy, presents with symptoms of vaginal thrush. After addressing her concerns, she inquires about pregnancy supplements. Ms. Smith has been taking a branded pregnancy multivitamin but wonders if it is necessary to continue taking it now that she is past the first trimester due to the cost. She is generally healthy, not taking any regular medications, and is receiving midwife-led care as her pregnancy has been deemed low risk. Additionally, there is no family history of spina bifida.

      What guidance should be provided to Ms. Smith?

      Your Answer: Folic acid preconception and until 12 weeks gestation, vitamin D throughout the whole pregnancy (except summer months)

      Explanation:

      Vitamin D supplementation has been a topic of interest for several years, and recent releases have provided some clarity on the matter. The Chief Medical Officer’s 2012 letter and the National Osteoporosis Society 2013 UK Vitamin D guideline recommend that certain groups take vitamin D supplements. These groups include pregnant and breastfeeding women, children aged 6 months to 5 years, adults over 65 years, and individuals who are not exposed to much sun, such as housebound patients.

      Testing for vitamin D deficiency is not necessary for most people. The NOS guidelines suggest that testing may be appropriate for patients with bone diseases that may be improved with vitamin D treatment, such as osteomalacia or Paget’s disease, and for patients with musculoskeletal symptoms that could be attributed to vitamin D deficiency, such as bone pain. However, patients with osteoporosis should always be given calcium/vitamin D supplements, and individuals at higher risk of vitamin D deficiency should be treated regardless of testing. Overall, vitamin D supplementation is recommended for certain groups, while testing for deficiency is only necessary in specific situations.

    • This question is part of the following fields:

      • Gynaecology And Breast
      4.8
      Seconds
  • Question 7 - A 60-year-old woman presents to breast clinic with a hard painless lump in...

    Correct

    • A 60-year-old woman presents to breast clinic with a hard painless lump in her left breast. After diagnosis of breast cancer, her clinician prescribe anastrozole. What are the potential side effects she should be cautioned about?

      Your Answer: Osteoporosis

      Explanation:

      Breast cancer treatment often involves hormonal therapy, particularly for those with estrogen receptor-positive tumors (which account for about 80% of all breast cancers). Aromatase inhibitors like anastrozole are commonly used in postmenopausal women to target estrogen production.

      However, one of the major concerns with hormonal therapy is the risk of osteoporosis. Women should undergo bone mineral density testing before starting treatment and regularly thereafter.

      Tamoxifen, another drug commonly used to treat breast cancer, has been associated with side effects such as deep vein thrombosis, endometrial cancer, and vaginal bleeding. However, urinary incontinence is not a known side effect of anastrozole.

      Anti-oestrogen drugs are used in the management of oestrogen receptor-positive breast cancer. Selective oEstrogen Receptor Modulators (SERM) such as Tamoxifen act as an oestrogen receptor antagonist and partial agonist. However, Tamoxifen may cause adverse effects such as menstrual disturbance, hot flashes, venous thromboembolism, and endometrial cancer. On the other hand, aromatase inhibitors like Anastrozole and Letrozole reduce peripheral oestrogen synthesis, which is important in postmenopausal women. Anastrozole is used for ER +ve breast cancer in this group. However, aromatase inhibitors may cause adverse effects such as osteoporosis, hot flashes, arthralgia, myalgia, and insomnia. NICE recommends a DEXA scan when initiating a patient on aromatase inhibitors for breast cancer.

    • This question is part of the following fields:

      • Gynaecology And Breast
      5.6
      Seconds
  • Question 8 - A 20-year-old woman presents to the clinic with complaints of breakthrough bleeding while...

    Correct

    • A 20-year-old woman presents to the clinic with complaints of breakthrough bleeding while taking her combined oral contraceptive pill containing 30 mcg ethinylestradiol with levonorgestrel. She started the pill two cycles ago and takes 21 active pills with a seven day pill-free interval. Although she is not currently sexually active, she plans to be in the near future. She reports no missed pills, recent illnesses, or other medication use. What is the probable cause of her breakthrough bleeding?

      Your Answer: Chlamydia infection

      Explanation:

      Breakthrough Bleeding and the Combined Pill

      Breakthrough bleeding is a common issue that can occur when taking the combined pill. It is important to first check compliance with pill usage, as missed pills or erratic usage can lead to bleeding problems. Other factors such as intercurrent illness or the use of other medications should also be considered. Pregnancy should be ruled out with a test, especially if any pills have been missed or pill efficacy has been compromised. Additionally, sexually transmitted infections should be considered and appropriate tests performed.

      For women who have recently started using the combined pill, breakthrough bleeding is a common occurrence in the first few months of use. It is important to discuss this with a healthcare provider and be reassured that it usually settles with time. If breakthrough bleeding persists, a change in approach may be necessary. Lower dose pills (20 mcg ethinyloestradiol) are more likely to cause breakthrough bleeding, and switching to a higher dose pill (30 mcg) may be an option. Overall, it is important to address breakthrough bleeding promptly to ensure the effectiveness and safety of the combined pill.

    • This question is part of the following fields:

      • Gynaecology And Breast
      3.9
      Seconds
  • Question 9 - A patient in her early 30s calls in tears, requesting to speak with...

    Correct

    • A patient in her early 30s calls in tears, requesting to speak with a doctor regarding her cervical screening test results. She has received a letter asking her to attend for colposcopy, and the results state 'Abnormal with borderline or low-grade cell changes.' She is distressed and wants to know if the test has detected cancer.

      What is the typical meaning of this result?

      Your Answer: Premalignant changes

      Explanation:

      The primary objective of cervical screening is to identify pre-cancerous alterations rather than detecting cancer.

      Understanding Cervical Cancer Screening in the UK

      Cervical cancer screening is a well-established program in the UK that aims to detect Premalignant changes in the cervix. This program is estimated to prevent 1,000-4,000 deaths per year. However, it should be noted that cervical adenocarcinomas, which account for around 15% of cases, are frequently undetected by screening.

      The screening program has evolved significantly in recent years. Initially, smears were examined for signs of dyskaryosis, which may indicate cervical intraepithelial neoplasia. However, the introduction of HPV testing allowed for further risk stratification. Patients with mild dyskaryosis who were HPV negative could be treated as having normal results. The NHS has now moved to an HPV first system, where a sample is tested for high-risk strains of human papillomavirus (hrHPV) first, and cytological examination is only performed if this is positive.

      All women between the ages of 25-64 years are offered a smear test. Women aged 25-49 years are screened every three years, while those aged 50-64 years are screened every five years. Cervical screening cannot be offered to women over 64, unlike breast screening, where patients can self-refer once past screening age. In Scotland, screening is offered from 25-64 every five years.

      In special situations, cervical screening in pregnancy is usually delayed until three months postpartum, unless there has been missed screening or previous abnormal smears. Women who have never been sexually active have a very low risk of developing cervical cancer and may wish to opt-out of screening.

      While there is limited evidence to support it, the current advice given out by the NHS is that the best time to take a cervical smear is around mid-cycle. Understanding the cervical cancer screening program in the UK is crucial for women to take control of their health and prevent cervical cancer.

    • This question is part of the following fields:

      • Gynaecology And Breast
      12.4
      Seconds
  • Question 10 - A 48-year-old patient has requested a consultation to discuss the outcome of her...

    Correct

    • A 48-year-old patient has requested a consultation to discuss the outcome of her recent smear test. The test showed normal cytology and was negative for high-risk human papillomavirus (hrHPV). However, her previous smear test 6 months ago showed normal cytology but was positive for hrHPV.

      What guidance would you provide to the patient after receiving her latest smear test result?

      Your Answer: Return to routine recall in 3 years time

      Explanation:

      If the result of the first repeat smear at 12 months for cervical cancer screening is negative for high-risk human papillomavirus (hrHPV), the patient can resume routine recall. This means they should undergo screening every 3 years from age 25-49 years or every 5 years from age 50-64 years. However, if the repeat test is positive again, the patient should undergo another HPV test in 12 months. If the cytology sample shows dyskaryosis, the patient should be referred for colposcopy.

      Understanding Cervical Cancer Screening Results

      The cervical cancer screening program has evolved significantly in recent years, with the introduction of HPV testing allowing for further risk stratification. The NHS now uses an HPV first system, where a sample is tested for high-risk strains of human papillomavirus (hrHPV) first, and cytological examination is only performed if this is positive.

      If the hrHPV test is negative, individuals can return to normal recall, unless they fall under the test of cure pathway, untreated CIN1 pathway, or require follow-up for incompletely excised cervical glandular intraepithelial neoplasia (CGIN) / stratified mucin producing intraepithelial lesion (SMILE) or cervical cancer. If the hrHPV test is positive, samples are examined cytologically, and if the cytology is abnormal, individuals will require colposcopy.

      If the cytology is normal but the hrHPV test is positive, the test is repeated at 12 months. If the repeat test is still hrHPV positive and cytology is normal, a further repeat test is done 12 months later. If the hrHPV test is negative at 24 months, individuals can return to normal recall, but if it is still positive, they will require colposcopy. If the sample is inadequate, it will need to be repeated within 3 months, and if two consecutive samples are inadequate, colposcopy will be required.

      For individuals who have previously had CIN, they should be invited for a test of cure repeat cervical sample in the community 6 months after treatment. The most common treatment for cervical intraepithelial neoplasia is large loop excision of transformation zone (LLETZ), which may be done during the initial colposcopy visit or at a later date depending on the individual clinic. Cryotherapy is an alternative technique.

    • This question is part of the following fields:

      • Gynaecology And Breast
      8.6
      Seconds

SESSION STATS - PERFORMANCE PER SPECIALTY

Gynaecology And Breast (10/10) 100%
Passmed